Urinary tract infection: Difference between revisions

Jump to navigation Jump to search
(34 intermediate revisions by 3 users not shown)
Line 1: Line 1:
<div style="-webkit-user-select: none;">
<div style="-webkit-user-select: none;">
{|class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;
{| class="infobox" style="position: fixed; top: 65%; right: 10px; margin: 0 0 0 0; border: 0; float: right;"
|-
|-
| {{#ev:youtube|https://https://www.youtube.com/watch?v=IE_ywuQoJSg|350}}
| {{#ev:youtube|https://https://www.youtube.com/watch?v=IE_ywuQoJSg|350}}
Line 8: Line 8:
{| class="infobox" style="float:right;"
{| class="infobox" style="float:right;"
|-
|-
| [[File:Siren.gif|30px|link=Urinary tract infection resident survival guide]]|| <br> || <br>
| [[File:Siren.gif|link=Urinary tract infection resident survival guide|41x41px]]|| <br> || <br>
| [[Urinary tract infection resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| [[Urinary tract infection resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
|}
|}
Line 20: Line 20:
A urinary tract infection is an [[infection]] that involves any part of the [[urinary tract]]. It can result due to the invasion by a [[bacteria]], [[virus]], [[fungus]] or any other [[pathogen]]. The most common cause of a urinary tract infection is a bacterial [[infection]]. Depending on the site of the [[infection]], a [[UTI|urinary tract infection]] can be classified as either upper or lower [[UTI]]. [[UTI|Lower UTI]] includes [[urethritis]], [[prostatitis]], [[asymptomatic bacteriuria]], and [[cystitis]] ([[bladder]] infection), where as [[UTI|upper UTI]] may include [[pyelonephritis]] (infection of the [[kidneys]]) and rarely urethritis (infection of the [[ureters]]). Each subtype of urinary tract infection can also be subclassified on the basis of duration, [[etiology]] or therapeutic approach as [[acute]], [[chronic]], or recurrent and as uncomplicated or complicated [[infections]].
A urinary tract infection is an [[infection]] that involves any part of the [[urinary tract]]. It can result due to the invasion by a [[bacteria]], [[virus]], [[fungus]] or any other [[pathogen]]. The most common cause of a urinary tract infection is a bacterial [[infection]]. Depending on the site of the [[infection]], a [[UTI|urinary tract infection]] can be classified as either upper or lower [[UTI]]. [[UTI|Lower UTI]] includes [[urethritis]], [[prostatitis]], [[asymptomatic bacteriuria]], and [[cystitis]] ([[bladder]] infection), where as [[UTI|upper UTI]] may include [[pyelonephritis]] (infection of the [[kidneys]]) and rarely urethritis (infection of the [[ureters]]). Each subtype of urinary tract infection can also be subclassified on the basis of duration, [[etiology]] or therapeutic approach as [[acute]], [[chronic]], or recurrent and as uncomplicated or complicated [[infections]].


The [[urine]] is normally sterile, a urinary tract infection occurs when the normally sterile [[urinary tract]] is infected by [[bacteria]], which leads to irritation and [[inflammation]]. [[Pyelonephritis]] and [[cystitis]] result mostly from ascending [[infections]] from the [[urethra]] ([[urethritis]]) but can also result from descending [[infections]] i.e hematogenous spread, or by the [[lymphatic system]]. The condition more often affects women, but can affect either gender and all age groups. The pathogenesis of a complicated UTI may include obstruction and stasis of [[urine]] flow.<ref name="pmid10969044">{{cite journal| author=Hooton TM| title=Pathogenesis of urinary tract infections: an update. | journal=J Antimicrob Chemother | year= 2000 | volume= 46 Suppl A | issue=  | pages= 1-7 | pmid=10969044 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10969044  }} </ref> Various factors are associated with the risk of developing a urinary tract infection. A common cause of the urinary tract infection in hospital settings is the [[urinary catheter]] placement. [[Diabetes]], [[Crohn's disease]], iatrogenic causes, [[endometriosis]], [[pelvic inflammatory disease]], [[urinary obstruction]], and [[bladder incontinence]] are some [[Risk factor|risk factors]] for acquiring a urinary tract infection. A thorough [[Physical examination|physical exam]] is very helpful in differentiating upper from lower urinary tract infections. Patients with an uncomplicated urinary tract infections are usually well-appearing. The [[symptoms]] may include abnormal [[urine color]] (cloudy), [[blood in the urine]], [[frequent urination]] or [[urgent need to urinate]], [[dysuria]], pressure in the lower pelvis or back, suprapubic pain, [[flank pain]], [[back pain]], [[fever]], [[nausea]], [[vomiting]], and [[chills]].<ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614  }} </ref> [[Urinalysis]] and [[urine culture]] are very helpful laboratory tests in diagnosing a urinary tract infection. Pyuria and either [[white blood cell]]s (WBCs) or [[red blood cells]] (RBCs) may be seen on urinalysis. ''[[Escherichia coli]] ("E. coli")'', a bacterium found in the lower [[gastrointestinal tract]] is one of the most common culprits. The individual infection must be differentiated from various causes of [[dysuria]] such as [[cystitis]], [[acute pyelonephritis]], [[urethritis]], [[prostatitis]], [[vulvovaginitis]], [[urethral stricture]]s or diverticula, [[benign prostatic hyperplasia]] and [[neoplasm]]s such as [[renal cell carcinoma]] and cancers of the [[Urinary bladder|bladder]], [[Prostate Gland|prostate]], and [[penis]]. Antimicrobial therapy is indicated in case of a [[symptomatic]] UTI.<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref>A large proportion of patients with acute uncomplicated urinary infections will recover without treatment within a few days or weeks. If left untreated, some patients may progress to develop recurrent infection, involve and infect other parts of the [[urinary tract]], [[hematuria]], and rarely [[renal failure]]. [[Prognosis]] is generally good for lower UTIs.<ref name=nid>Urinary Tract Infections in Adults. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/Pages/facts.aspx. Accessed on February 9, 2016</ref> The treatment of a UTI depends on the type of the disease, the disease course (acute uncomplicated vs. complicated), [[History & Symptoms|history]] of the individual and the rates of [[Drug resistance|resistance]] in the community. Preventative measures to avoid a UTI include Abstinence, be faithful, use a condom|abstinence from sexual activity, use of [[barrier contraception]] during sexual intercourse, urinating after intercourse, increasing fluid intake and frequency of urination, and use of [[estrogen]] (among [[Postmenopausal|post-menopausal]] women.
The [[urine]] is normally sterile, a urinary tract infection occurs when the normally sterile [[urinary tract]] is infected by [[bacteria]], which leads to irritation and [[inflammation]]. [[Pyelonephritis]] and [[cystitis]] result mostly from ascending [[infections]] from the [[urethra]] ([[urethritis]]) but can also result from descending [[infections]] such as hematogenous spread, or by the [[lymphatic system]]. The condition more often affects women, but can affect either gender and all age groups. The pathogenesis of a complicated UTI may include obstruction and stasis of [[urine]] flow.<ref name="pmid10969044">{{cite journal| author=Hooton TM| title=Pathogenesis of urinary tract infections: an update. | journal=J Antimicrob Chemother | year= 2000 | volume= 46 Suppl A | issue=  | pages= 1-7 | pmid=10969044 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10969044  }} </ref> Various factors are associated with the risk of developing a urinary tract infection. A common cause of the urinary tract infection in hospital settings is the [[urinary catheter]] placement. [[Diabetes]], [[Crohn's disease]], iatrogenic causes, [[endometriosis]], [[pelvic inflammatory disease]], [[urinary obstruction]], and [[bladder incontinence]] are some [[Risk factor|risk factors]] for acquiring a urinary tract infection. A thorough [[Physical examination|physical exam]] is very helpful in differentiating upper from lower urinary tract infections. Patients with an uncomplicated urinary tract infections are usually well–appearing. The [[symptoms]] may include abnormal [[urine color]] (cloudy), [[blood in the urine]], [[frequent urination]] or [[urgent need to urinate]], [[dysuria]], pressure in the lower pelvis or back, suprapubic pain, [[flank pain]], [[back pain]], [[fever]], [[nausea]], [[vomiting]], and [[chills]].<ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614  }} </ref> [[Urinalysis]] and [[urine culture]] are very helpful laboratory tests in diagnosing a urinary tract infection. Pyuria and either [[white blood cell]]s (WBCs) or [[red blood cells]] (RBCs) may be seen on urinalysis. ''[[Escherichia coli]] ("E. coli")'', a bacterium found in the lower [[gastrointestinal tract]] is one of the most common culprits. The individual infection must be differentiated from various causes of [[dysuria]] such as [[cystitis]], [[acute pyelonephritis]], [[urethritis]], [[prostatitis]], [[vulvovaginitis]], [[urethral stricture]]s or diverticula, [[benign prostatic hyperplasia]] and [[neoplasm]]s such as [[renal cell carcinoma]] and cancers of the [[Urinary bladder|bladder]], [[Prostate Gland|prostate]], and [[penis]]. Antimicrobial therapy is indicated in case of a [[symptomatic]] UTI.<ref name="pmid11989635">{{cite journal| author=Bremnor JD, Sadovsky R| title=Evaluation of dysuria in adults. | journal=Am Fam Physician | year= 2002 | volume= 65 | issue= 8 | pages= 1589-96 | pmid=11989635 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11989635  }} </ref><ref name="pmid9606306">{{cite journal| author=Kurowski K| title=The woman with dysuria. | journal=Am Fam Physician | year= 1998 | volume= 57 | issue= 9 | pages= 2155-64, 2169-70 | pmid=9606306 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9606306  }} </ref> A large proportion of patients with acute uncomplicated urinary infections will recover without treatment within a few days or weeks. If left untreated, some patients may progress to develop recurrent infection, involve and infect other parts of the [[urinary tract]], [[hematuria]], and rarely [[renal failure]]. [[Prognosis]] is generally good for lower UTIs.<ref name="nid">Urinary Tract Infections in Adults. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/Pages/facts.aspx. Accessed on February 9, 2016</ref> The treatment of a UTI depends on the type of the disease, the disease course (acute uncomplicated versus complicated), [[History & Symptoms|history]] of the individual, and the rates of [[Drug resistance|drug resistance]] in the community. Preventative measures to avoid a UTI include abstinence, being faithful, using a condom, using [[barrier contraception]] during sexual intercourse, urinating after intercourse, increasing fluid intake and frequency of urination, and use of [[estrogen]] among [[Postmenopausal|postmenopausal]] women.


==Classification==
==Classification==
Urinary tract infections can be classified as follows:
Urinary tract infections can be classified as follows:
 
=== Anatomical Classification ===
{{familytree/start}}
{{familytree/start}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Urinary Tract Infections}}
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | |A01= Urinary tract infections}}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | | |,|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|-|.| }}
{{familytree | | | | B01 | | | | | | | | | | | | | | | | B02 | |B01=Upper UTI | B02 = Lower UTI}}
{{familytree | | | | B01 | | | | | | | | | | | | | | | | B02 | |B01=Upper UTI | B02 = Lower UTI}}
Line 34: Line 34:
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree | | | | |!| | | | |!| | | | | | | | | |!| | | | | | | | | | | | }}
{{familytree |boxstyle=text-align: left; | | | | D01 | | | D02 | | | | | | | | D03 | | | | | | | | | | D01 = • Acute Uncomplicated<br>• Acute Complicated <br>• Chronic <br>•  Emphysematous <br>• Xantho- granulomatous| D02 = • Acute Uncomplicated<br>• Complicated<br>• Recurrent/ Chronic | D03 = • Acute Bacterial <br> • Chronic bacterial <br>• Chronic Inflammatory<br>• Chronic non-inflammatory <br>• Asymptomatic }}
{{familytree |boxstyle=text-align: left; | | | | D01 | | | D02 | | | | | | | | D03 | | | | | | | | | | D01 = • Acute uncomplicated<br>• Acute complicated <br>• Chronic <br>•Emphysematous <br>• Xantho-granulomatous| D02 = • Acute uncomplicated<br>• Complicated<br>•Recurrent/chronic | D03 = • Acute bacterial<br>• Chronic bacterial<br>• Chronic inflammatory<br>• Chronic non-inflammatory<br>•Asymptomatic }}
{{familytree/end}}
{{familytree/end}}
=== Classification Based on Symptoms ===
This classification is primarily used to estimate duration of antibiotic treatment.<ref name="pmid18242357">{{cite journal| author=Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB| title=A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. | journal=Urology | year= 2008 | volume= 71 | issue= 1 | pages= 17-22 | pmid=18242357 | doi=10.1016/j.urology.2007.09.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18242357  }} </ref>
{{Family tree/start}}•
{{Family tree | | | | A01 | | | |A01= UTI}}
{{Family tree | | | | |!| | | | | }}
{{familytree |boxstyle=text-align: left; | | | | B01 | | | |B01= • [[Fever]] > 99.9 F OR<br> • [[Flank pain]] or [[CVA tenderness]] with [[pyuria]] OR<br> • [[Fever]] with [[pyuria]] OR<br> • [[Sepsis]] OR<br> • Systemic signs such as chills, rigors, fatigue OR<br> • UTI in men OR<br> • Anatomical renal defects OR}}
{{Family tree | |,|-|-|^|-|-|.| | }}
{{Family tree | C01 | | | | C02 |C01= Present  (anyone)| C02= Absent}}
{{Family tree | |!| | | | | |!| | }}
{{Family tree | D01 | | | | D02 |D01= Treat as complicated UTI <br> • 5 - 14 days based on choice of antibiotics| D02= Treat as uncomplicated UTI <br> • 5 days}}
{{Family tree/end}}


==Causes==
==Causes==
The various causes of urinary tract infections include:
The various causes of urinary tract infections include:
{| class="wikitable"
{|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Common Pathogens
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Common Pathogens
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Pyelonephritis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pyelonephritis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Cystitis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cystitis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Urethritis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urethritis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Prostatitis]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Prostatitis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Asymptomatic bacteriuria|Asymptomatic  Bacteriuria]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Asymptomatic  Bacteriuria
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Ecoli]]*<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Ecoli*<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
Line 87: Line 100:
  | pmid = 20444967
  | pmid = 20444967
}}</ref>
}}</ref>
|+ (70%)
| align="center" style="background:#F5F5F5;" + | + (70%)
|+ (78.6%)
| align="center" style="background:#F5F5F5;" + | + (78.6%)
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | + (58%)
| align="center" style="background:#F5F5F5;" + | + (80%)
|-
|-
|+ (58%)
! align="left" style="background:#DCDCDC;" + |Klebsiella<ref>{{Cite journal
|+ (80%)
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Klebsiella]]<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
Line 104: Line 117:
  | pmid = 10433573
  | pmid = 10433573
}}</ref>
}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +
|+
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
|+
! align="left" style="background:#DCDCDC;" + |Proteus<ref>{{Cite journal
|+
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Proteus]]<ref>{{Cite journal
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | author = [[R. M. Echols]], [[R. L. Tosiello]], [[D. C. Haverstock]] & [[A. D. Tice]]
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
  | title = Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis
Line 121: Line 134:
  | pmid = 10433573
  | pmid = 10433573
}}</ref>
}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Neisseria gonorrhoeae]]<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Neisseria gonorrhoeae<ref>{{Cite journal
  | author = [[Stephanie N. Taylor]], [[Oliver Liesenfeld]], [[Rebecca A. Lillis]], [[Barbara A. Body]], [[Melinda Nye]], [[James Williams]], [[Carol Eisenhut]], [[Edward W. 3rd Hook]] & [[Barbara Van Der Pol]]
  | author = [[Stephanie N. Taylor]], [[Oliver Liesenfeld]], [[Rebecca A. Lillis]], [[Barbara A. Body]], [[Melinda Nye]], [[James Williams]], [[Carol Eisenhut]], [[Edward W. 3rd Hook]] & [[Barbara Van Der Pol]]
  | title = Evaluation of the Roche cobas(R) CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine
  | title = Evaluation of the Roche cobas(R) CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine
Line 138: Line 151:
  | pmid = 22706217
  | pmid = 22706217
}}</ref>
}}</ref>
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|+(21.6%)
| align="center" style="background:#F5F5F5;" + | + (21.6%)
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Pseudomonas]]<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Pseudomonas<ref>{{Cite journal
  | author = [[Allan Ronald]]
  | author = [[Allan Ronald]]
  | title = The etiology of urinary tract infection: traditional and emerging pathogens
  | title = The etiology of urinary tract infection: traditional and emerging pathogens
Line 153: Line 166:
  | pmid = 12113867
  | pmid = 12113867
}}</ref>
}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Staphylococcus]]
! align="left" style="background:#DCDCDC;" + |Staphylococcus
|+
| align="center" style="background:#F5F5F5;" + | +
|+
| align="center" style="background:#F5F5F5;" + | +
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|+
| align="center" style="background:#F5F5F5;" + | +
|+
| align="center" style="background:#F5F5F5;" + | +  
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Chlamydia trachomatis]]<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Chlamydia trachomatis<ref>{{Cite journal
  | author = [[J. Dimitrakov]], [[V. Ganev]], [[T. Zlatanov]], [[I. Detchev]], [[A. Horvat]], [[S. Kirov]], [[I. Vatchkova]] & [[D. Dimitrakov]]
  | author = [[J. Dimitrakov]], [[V. Ganev]], [[T. Zlatanov]], [[I. Detchev]], [[A. Horvat]], [[S. Kirov]], [[I. Vatchkova]] & [[D. Dimitrakov]]
  | title = PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis
  | title = PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis
Line 195: Line 208:
  | pmid = 27107783
  | pmid = 27107783
}}</ref>
}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|+ (20-30%)
| align="center" style="background:#F5F5F5;" + | + (20–30%)
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|-
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Mycoplasma]]<ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Mycoplasma<ref>{{Cite journal
  | author = [[Iu L. Naboka]], [[L. I. Vasil'eva]], [[M. I. Kogan]], [[I. A. Gudima]] & [[I. Iu Suchkov]]
  | author = [[Iu L. Naboka]], [[L. I. Vasil'eva]], [[M. I. Kogan]], [[I. A. Gudima]] & [[I. Iu Suchkov]]
  | title = &#91;Microbial associations defecting in children with chronic pyelonephritis&#93;
  | title = &#91;Microbial associations defecting in children with chronic pyelonephritis&#93;
Line 218: Line 231:
  | pmid = 20063785
  | pmid = 20063785
}}</ref>
}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|-
|-
|[[Trichomonas vaginalis|Trichomonas]]<ref>{{Hoffman, David J., et al. "Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease." Journal of perinatology 23.1 (2003): 59-61.}}</ref><ref>{{Cite journal
! align="left" style="background:#DCDCDC;" + |Trichomonas<ref>{{Hoffman, David J., et al. "Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease." Journal of perinatology 23.1 (2003): 59-61.}}</ref><ref>{{Cite journal
  | author = [[L. SYLVESTRE]], [[M. BELANGER]] & [[Z. GALLAI]]
  | author = [[L. SYLVESTRE]], [[M. BELANGER]] & [[Z. GALLAI]]
  | title = Urogenital trichomoniasis in the male: review of the literature and report on treatment of 37 patients by a new nitroimidazole derivative (Flagyl)
  | title = Urogenital trichomoniasis in the male: review of the literature and report on treatment of 37 patients by a new nitroimidazole derivative (Flagyl)
Line 233: Line 246:
  | pmid = 13774369
  | pmid = 13774369
}}</ref><ref>{{Kuberski, Tim. "Trichomonas vaginalis associated with nongonococcal urethritis and prostatitis." Sexually transmitted diseases 7.3 (1979): 135-136.}}</ref>
}}</ref><ref>{{Kuberski, Tim. "Trichomonas vaginalis associated with nongonococcal urethritis and prostatitis." Sexually transmitted diseases 7.3 (1979): 135-136.}}</ref>
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|+
| align="center" style="background:#F5F5F5;" + | +  
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" + |–
|}
|}
* Ecoli is the most common cause of all urinary tract infections<ref>{{Cite journal
<small>*Ecoli is the most common cause of all urinary tract infections<ref>{{Cite journal
  | author = [[Matthew J. Perkins]] & [[Catherine F. Decker]]
  | author = [[Matthew J. Perkins]] & [[Catherine F. Decker]]
  | title = Non-gonococcal urethritis
  | title = Non-gonococcal urethritis
Line 249: Line 262:
  | doi = 10.1016/j.disamonth.2016.03.011
  | doi = 10.1016/j.disamonth.2016.03.011
  | pmid = 27107783
  | pmid = 27107783
}}</ref>
}}</ref></small>
*'''For more causes of [[pyelonephritis]] [[Pyelonephritis causes|click here]].'''
*'''For more causes of [[pyelonephritis]], [[Pyelonephritis causes|click here]].'''
*'''For more causes of [[cystitis]] [[Cystitis causes|click here]].'''
*'''For more causes of [[cystitis]], [[Cystitis causes|click here]].'''
*'''For more causes of [[urethritis]] [[Urethritis causes|click here]].'''
*'''For more causes of [[urethritis]], [[Urethritis causes|click here]].'''
*'''For more causes of [[prostatitis]] [[Prostatitis causes|click here]].'''
*'''For more causes of [[prostatitis]], [[Prostatitis causes|click here]].'''
*'''For more causes of [[asymptomatic bacteriuria]] [[Asymptomatic bacteriuria#Causes|click here]].'''
*'''For more causes of [[asymptomatic bacteriuria]], [[Asymptomatic bacteriuria#Causes|click here]].'''


==Differential Diagnosis==
==Differential Diagnosis==
Line 260: Line 273:


{|
{|
|-style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="4" |<small>Physical Examination</small>
| colspan="5" |<small>Symptoms
! colspan="1" rowspan="2" |<small>Past medical history</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Hematuria</small>
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Pyuria</small>
Line 280: Line 286:
!<small>Urgency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|-
| colspan="4" |'''Differentiating amongst different types of Urinary Tract Infections:'''
| colspan="15" |'''Differentiating amongst different types of urinary tract infections:'''
| colspan="11" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyelonephritis|'''Pyelonephritis''']]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | [[Flank pain|Flank]] or [[costovertebral angle]]
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |  
*[[Leukocytes]]
*[[Leukocytes]]
*[[Nitrite test|Nitrite]] +ve
*[[Nitrite test|Nitrite]] +ve
| style="background: #F5F5F5; padding: 5px;" |Identifies causative [[bacteria]]
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]]
| style="background: #F5F5F5; padding: 5px;" |Imaging and culture
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| style="background: #F5F5F5; padding: 5px;" | ✔
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |[[Flank pain|Flank]] or [[costovertebral angle]]
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |
* History of [[pyelonephritis]]
* History of [[pyelonephritis]]
* Recent history of [[hospitalisation]]
* Recent history of [[hospitalisation]]
* [[Nephrolithiasis]]
* [[Nephrolithiasis]]
* [[Immunosupression]]
* [[Immunosupression]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* [[Flank pain|Costovertebral angle tenderness]]
* [[Flank pain|Costovertebral angle tenderness]]
* Patient is in acute distress
* Patient is in acute distress
* Look for obstructive causes
* Look for obstructive causes
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cystitis|'''Cystitis''']]
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |  +
| align="center" style="background:#F5F5F5;" + | Suprapubic
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |  
*[[Nitrite test|Nitrite]] +ve  
*[[Nitrite test|Nitrite]] +ve  
 
*[[Leukocyte esterase]] +ve
*[[Leukocyte esterase]]+ve
 
*[[White blood cells|WBCs]]
*[[White blood cells|WBCs]]
*[[RBCs]]
*[[RBCs]]
|style="background: #F5F5F5; padding: 5px; text-align:center"|>100,000CFU/mL
| align="center" style="background:#F5F5F5;" + | >100,000CFU/mL
| style="background: #F5F5F5; padding: 5px;" |[[Urine culture]]
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
|style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| align="left" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" |Suprapubic
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
|style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
|style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px;" | ✔
|style="background: #F5F5F5; padding: 5px;" | ✔
|style="background: #F5F5F5; padding: 5px;" | ✔
|style="background: #F5F5F5; padding: 5px;" |
*Recent catheterisation
*Recent catheterisation
*[[Pregnancy]]
*[[Pregnancy]]
*recent intercourse
*Recent intercourse
*[[Diabetes]]
*[[Diabetes]]
*Personal or [[family history]] of [[UTI]]
*Personal or [[family history]] of [[UTI]]
*Known abnormality of the [[urinary tract]]
*Known abnormality of the [[urinary tract]]
*[[BPH]] or [[HIV]]
*[[BPH]]
|style="background: #F5F5F5; padding: 5px;" |
*[[HIV]]
| align="left" style="background:#F5F5F5;" + |
* Imaging studies help differentiate the various types
* Imaging studies help differentiate the various types
* May acompany [[back pain]], [[nausea]], [[vomiting]] and [[chills]]
* May accompany [[back pain]], [[nausea]], [[vomiting]], and [[chills]]
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Urethritis|'''Urethritis''']]
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | + 
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | [[Urethral discharge]]
| align="center" style="background:#F5F5F5;" + |  +
| align="left" style="background:#F5F5F5;" + |  
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Positive [[leukocyte esterase]] test or >10 [[White blood cells|WBCs]]
*Mucous threads in the morning [[urine]]
*Mucous threads in the morning [[urine]]
 
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & mucoid or [[purulent]] [[discharge]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
[[Gram stain]]
&
Mucoid or [[purulent]] [[discharge]]
|style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| style="background: #F5F5F5; padding: 5px;text-align:center" |[[Urethral discharge]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
|style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
|style="background: #F5F5F5; padding: 5px;" | ✔
|style="background: #F5F5F5; padding: 5px;" |
* Prior [[STD]]s
* Prior [[STD]]s
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary tract infection|Urinary tract infections]]
Line 367: Line 372:
* Recent intercourse
* Recent intercourse
* Recent [[catheterization]]
* Recent [[catheterization]]
|style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*[[Purulent]] [[discharge]] may suggest [[gonorrhoea]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Exclusive [[dysuria]] suggest [[Chlamydia]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
*Painful genital [[ulcers]] with [[dysuria]] suggest [[HSV]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Prostatitis|'''Prostatitis''']]
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + |
*10-20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" |  
| align="center" style="background:#F5F5F5;" + | +
[[Urine culture]]
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" |
*10–20 [[leukocytes]] for acute and chronic [[bacterial]] subtypes
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | Identifies causative [[bacteria]] (in [[bacterial]] subtypes)
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + | [[Urine culture]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
* [[Urogenital]] disorders
* [[Urogenital]] disorders
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* Recent [[catheterization]] or other [[genitourinary]] instrumentation
* History of [[UTI|UTIs]]
* History of [[UTI|UTIs]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* In [[acute prostatitis]], [[palpation]] reveals a [[Tenderness|tender]] and [[enlarged prostate]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
*[[Tenderness|Tender]] and [[enlarged prostate]] in [[acute prostatitis]]<sup>[[Prostatitis physical examination|[1][3]]]</sup>
* In chronic [[prostatitis]], [[palpation]] reveals a tender and soft (boggy) [[prostate]]<sup>[[Prostatitis physical examination|[1]]]</sup>
*Tender and soft (boggy) [[prostate]] in chronic [[prostatitis]]<sup>[[Prostatitis physical examination|[1]]]</sup>
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]]
* A [[prostate massage]] should never be done in a patient with suspected [[acute prostatitis]], since it may induce [[sepsis]].
|-
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|-
| colspan="3" |'''Differentiating UTIs from Other Diseases:'''
| colspan="15" |'''Differentiating UTIs from other diseases:'''
| colspan="12" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Vulvovagintis|'''Vulvovagintis''']]
 
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + |
[[Gram stain]]
| align="center" style="background:#F5F5F5;" + | +
&
| align="center" style="background:#F5F5F5;" + | +
Culture of discharge
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + |[[Vaginal discharge]] 
| style="background: #F5F5F5; padding: 5px;text-align:center" |-
| align="center" style="background:#F5F5F5;" + | +
|style="background: #F5F5F5; padding: 5px;text-align:center" | [[Vaginal discharge]] 
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| align="center" style="background:#F5F5F5;" + | [[Gram stain]] & [[culture]] of discharge
| style="background: #F5F5F5; padding: 5px;" |-
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Number and type of sexual partners (new, casual, or regular)
* Number and type of sexual partners (new, casual, or regular)
* Prior [[STDs]]
* Prior [[STDs]]
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
* Previous history of symptomatic BV in female partner (in [[homosexual]] women)
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Fishy [[odor]] from the [[vagina]] (Whiff test)
* Thin, white/gray homogeneous [[vaginal discharge]]
* Thin, white/gray homogeneous [[vaginal discharge]]
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* [[Microscopy]] (wet prep) and vaginal [[pH]] 
* Clue cells
* Clue cells
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Cervicitis|'''Cervicitis''']]
|style="background: #F5F5F5; padding: 5px; text-align:center"|-
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center"|-
| align="center" style="background:#F5F5F5;" + | +
|style="background: #F5F5F5; padding: 5px; text-align:center" |culture for [[gonococcal]] cervicitis
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center"|
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px; text-align:center" |Cervical
| align="center" style="background:#F5F5F5;" + | +
|style="background: #F5F5F5; padding: 5px; text-align:center"|
| align="center" style="background:#F5F5F5;" + | +
 
| align="center" style="background:#F5F5F5;" + | Cervical
endocervical exudate
| align="center" style="background:#F5F5F5;" + | Endocervical exudate
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center" |-
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px; text-align:center"|-
| align="center" style="background:#F5F5F5;" + | [[Culture]] for [[gonococcal]] cervicitis
| style="background: #F5F5F5; padding: 5px; text-align:center" |-
| align="left" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px; text-align:center" |
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal bleeding]] after intercourse or after [[menopause]]
* Abnormal [[vaginal discharge]]
* Abnormal [[vaginal discharge]]
* Painful sexual intercourse
* Painful sexual intercourse
* Pressure or heaviness in the [[pelvis]]
* Pressure or heaviness in the [[pelvis]]
| style="background: #F5F5F5; padding: 5px; text-align:center" |
| align="left" style="background:#F5F5F5;" + |
*[[Purulent]] or [[mucopurulent]] endocervical exudate
*[[Purulent]] or [[mucopurulent]] endocervical exudate
 
*Sustained endocervical [[bleeding]] easily induced by a cotton swab  
*Sustained endocervical bleeding easily induced by a cotton swab  
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by ''[[C. trachomatis]]'' or ''[[N. gonorrhea]]''
 
*>10 [[WBC]] in vaginal fluid, in the absence of [[trichomoniasis]], may indicate endocervical [[inflammation]] caused specifically by [[C. trachomatis]] or [[N. gonorrhea]]
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymitis|'''Epididymitis''']]
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | [[Testicular]] & suprapubic
| align="center" style="background:#F5F5F5;" + | +/– [[urethral discharge]]
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |  
*[[Hematuria]] may be seen
*[[Hematuria]] may be seen
|style="background: #F5F5F5; padding: 5px;" |✔
| align="center" style="background:#F5F5F5;" + | +
| style="background: #F5F5F5; padding: 5px;" | Culture
| align="center" style="background:#F5F5F5;" + | [[Culture]]
|style="background: #F5F5F5; padding: 5px;" |✔
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;text-align:center" |
*Unilateral, gradual, and [[Localized disease|localized]] [[scrotal pain]] posterior to the [[testis]]
[[Testicular]]
&
Suprapubic
|style="background: #F5F5F5; padding: 5px;" | +/- [[urethral discharge]]
| style="background: #F5F5F5; padding: 5px;" |✔ 
| style="background: #F5F5F5; padding: 5px; text-align:center" |✔
| style="background: #F5F5F5; padding: 5px;" | -
|style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |  
*[[Scrotal pain]]:  starts gradually, is usually unilateral and [[Localized disease|localized]] posterior to the testis
*[[Scrotal swelling]]
*[[Scrotal swelling]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*[[Scrotum|Scrotal]] wall [[erythema]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
*Constitutional symptoms: feeling warm, [[chills]], [[nausea and vomiting]]
 
| align="left" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*[[Ultrasound]] in patients with [[Testicular pain|acute testicular pain]] to assess for [[testicular torsion]]
*If equivocal do surgical exploration
*If equivocal do surgical exploration
|-
|-
|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Syphilis]] ([[STDs|STD]])
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Syphilis]]'''
|style="background: #F5F5F5; padding: 5px;" | -
'''([[STDs|STD]])'''
|style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |[[Dark field microscopy|Darkfield microscopy]]
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | +/-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +/–
|style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" | -
| align="center" style="background:#F5F5F5;" + | +
|style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
|style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | [[Dark field microscopy|Darkfield microscopy]]
| align="left" style="background:#F5F5F5;" + |  
* History of [[STD]]
* History of [[STD]]
* [[HIV AIDS|HIV]]
* [[HIV AIDS|HIV]]
* [[Immunosupression]]
* [[Immunosupression]]
* Previous history of [[chancre]]
* Previous history of [[chancre]]
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |  
* May be asymptomatic
* May be asymptomatic
* Painless [[chancre]] in [[primary syphilis]]
* Painless [[chancre]] in [[primary syphilis]]
Line 505: Line 517:
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
* [[Tertiary syphilis]] can have [[neurosyphilis]], [[cardiovascular syphilis]] and gummas
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[BPH]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[BPH|'''BPH''']]
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="left" style="background:#F5F5F5;" + |  
*[[Hematuria]] may be seen
*[[Hematuria]] may be seen
| style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | [[Digital rectal examination|DRE]]
[[Digital rectal examination|DRE]]
&
&
Serum [[PSA]]
Serum [[PSA]]
| style="background: #F5F5F5; padding: 5px;" |-
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |✔
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px;" |
* Sudden inability to [[urinate]]
* Sudden inability to [[urinate]]
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary tract infection|Urinary tract infections]]
* [[Urinary stone|Urinary stones]]
* [[Urinary stone|Urinary stones]]
* Damage to the [[Kidney|kidneys]]
* Damage to the [[Kidney|kidneys]]
* [[Hematuria|Blood in the urine]]
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;" |
* Involves mainly central or transitional zone  
* Involves mainly central or transitional zone  
* [[Hyperplasia]] rather than [[Organ hypertrophy|hypertrophy]]
* [[Hyperplasia]] rather than [[Organ hypertrophy|hypertrophy]]
Line 534: Line 544:
* [[Nocturia]]
* [[Nocturia]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Neoplasms  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Neoplasms'''
| style="background: #F5F5F5; padding: 5px;" |
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +/–
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | –
| align="center" style="background:#F5F5F5;" + | +
| align="left" style="background:#F5F5F5;" + |  
*[[Hematuria]] may be seen
*[[Hematuria]] may be seen
| style="background: #F5F5F5; padding: 5px;" |-
| align="center" style="background:#F5F5F5;" + |
| style="background: #F5F5F5; padding: 5px;" |[[Imaging]] and [[biopsy]]
| align="center" style="background:#F5F5F5;" + | [[Imaging]] and [[biopsy]]
| style="background: #F5F5F5; padding: 5px; text-align:center" | +-
| align="left" style="background:#F5F5F5;" + |  
| style="background: #F5F5F5; padding: 5px;text-align:center" |-
| style="background: #F5F5F5; padding: 5px;text-align:center" |-
| style="background: #F5F5F5; padding: 5px;" | ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px; text-align:center" | ✔
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" |
* Sudden inability to [[urinate]]
* Sudden inability to [[urinate]]
* Recurrent [[Urinary tract infection|urinary tract infections]]
* Recurrent [[Urinary tract infection|urinary tract infections]]
* [[Weight loss]] and other constitutional symptoms
* [[Weight loss]] and other constitutional symptoms
| style="background: #F5F5F5; padding: 5px;" |
| align="left" style="background:#F5F5F5;" + |  
* [[Cachexia]]
* [[Cachexia]]
* Gradual progression
* Gradual progression
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |<small>Diseases</small>
| colspan="5" |<small>'''Symptoms'''
! colspan="4" |<small>Physical Examination</small>
! colspan="3" |<small>Diagnostic tests</small>
! colspan="1" rowspan="2" |<small>Past medical history</small>
! rowspan="2" |<small>Other Findings</small>
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!<small>Hematuria</small>
!<small>Pyuria</small>
!<small>Frequency</small>
!<small>Urgency</small>
!<small>Dysuria</small>
!<small>Fever</small>
!<small>Tenderness</small>
!<small>Discharge</small>
!<small>Inguinal Lymphadenopathy</small>
!<small>Urinalysis</small>
!<small>Urine Culture</small>
!<small>Gold Standard
|-
|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
Line 567: Line 596:
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Primary care]]
[[Category:Primary care]]
[[Category:Emergency medicine]]

Revision as of 20:46, 9 December 2019

https://https://www.youtube.com/watch?v=IE_ywuQoJSg%7C350}}


Resident
Survival
Guide

For patient information click here

Urinary Tract Infection Microchapters

Patient Information

Overview

Classification

Pyelonephritis
Cystitis
Prostatitis
Urethritis
Asymptomatic bacteriuria

Causes

Differential Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]

Synonyms and keywords: UTI

Overview

A urinary tract infection is an infection that involves any part of the urinary tract. It can result due to the invasion by a bacteria, virus, fungus or any other pathogen. The most common cause of a urinary tract infection is a bacterial infection. Depending on the site of the infection, a urinary tract infection can be classified as either upper or lower UTI. Lower UTI includes urethritis, prostatitis, asymptomatic bacteriuria, and cystitis (bladder infection), where as upper UTI may include pyelonephritis (infection of the kidneys) and rarely urethritis (infection of the ureters). Each subtype of urinary tract infection can also be subclassified on the basis of duration, etiology or therapeutic approach as acute, chronic, or recurrent and as uncomplicated or complicated infections.

The urine is normally sterile, a urinary tract infection occurs when the normally sterile urinary tract is infected by bacteria, which leads to irritation and inflammation. Pyelonephritis and cystitis result mostly from ascending infections from the urethra (urethritis) but can also result from descending infections such as hematogenous spread, or by the lymphatic system. The condition more often affects women, but can affect either gender and all age groups. The pathogenesis of a complicated UTI may include obstruction and stasis of urine flow.[1] Various factors are associated with the risk of developing a urinary tract infection. A common cause of the urinary tract infection in hospital settings is the urinary catheter placement. Diabetes, Crohn's disease, iatrogenic causes, endometriosis, pelvic inflammatory disease, urinary obstruction, and bladder incontinence are some risk factors for acquiring a urinary tract infection. A thorough physical exam is very helpful in differentiating upper from lower urinary tract infections. Patients with an uncomplicated urinary tract infections are usually well–appearing. The symptoms may include abnormal urine color (cloudy), blood in the urine, frequent urination or urgent need to urinate, dysuria, pressure in the lower pelvis or back, suprapubic pain, flank pain, back pain, fever, nausea, vomiting, and chills.[2] Urinalysis and urine culture are very helpful laboratory tests in diagnosing a urinary tract infection. Pyuria and either white blood cells (WBCs) or red blood cells (RBCs) may be seen on urinalysis. Escherichia coli ("E. coli"), a bacterium found in the lower gastrointestinal tract is one of the most common culprits. The individual infection must be differentiated from various causes of dysuria such as cystitis, acute pyelonephritis, urethritis, prostatitis, vulvovaginitis, urethral strictures or diverticula, benign prostatic hyperplasia and neoplasms such as renal cell carcinoma and cancers of the bladder, prostate, and penis. Antimicrobial therapy is indicated in case of a symptomatic UTI.[3][4] A large proportion of patients with acute uncomplicated urinary infections will recover without treatment within a few days or weeks. If left untreated, some patients may progress to develop recurrent infection, involve and infect other parts of the urinary tract, hematuria, and rarely renal failure. Prognosis is generally good for lower UTIs.[5] The treatment of a UTI depends on the type of the disease, the disease course (acute uncomplicated versus complicated), history of the individual, and the rates of drug resistance in the community. Preventative measures to avoid a UTI include abstinence, being faithful, using a condom, using barrier contraception during sexual intercourse, urinating after intercourse, increasing fluid intake and frequency of urination, and use of estrogen among postmenopausal women.

Classification

Urinary tract infections can be classified as follows:

Anatomical Classification

 
 
 
 
 
 
 
 
 
 
 
 
Urinary tract infections
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Upper UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lower UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pyelonephritis
 
 
Cystitis
 
 
 
 
 
 
 
Prostatitis
 
 
 
Urethritis
 
 
 
 
 
Asymptomatic bacteriuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Acute uncomplicated
• Acute complicated
• Chronic
•Emphysematous
• Xantho-granulomatous
 
 
• Acute uncomplicated
• Complicated
•Recurrent/chronic
 
 
 
 
 
 
 
• Acute bacterial
• Chronic bacterial
• Chronic inflammatory
• Chronic non-inflammatory
•Asymptomatic
 
 
 
 
 
 
 
 
 

Classification Based on Symptoms

This classification is primarily used to estimate duration of antibiotic treatment.[6]

 
 
 
UTI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fever > 99.9 F OR
Flank pain or CVA tenderness with pyuria OR
Fever with pyuria OR
Sepsis OR
• Systemic signs such as chills, rigors, fatigue OR
• UTI in men OR
• Anatomical renal defects OR
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Present (anyone)
 
 
 
Absent
 
 
 
 
 
 
 
 
 
 
 
 
Treat as complicated UTI
• 5 - 14 days based on choice of antibiotics
 
 
 
Treat as uncomplicated UTI
• 5 days

Causes

The various causes of urinary tract infections include:

Common Pathogens Pyelonephritis Cystitis Urethritis Prostatitis Asymptomatic Bacteriuria
Ecoli*[7][8][9][10] + (70%) + (78.6%) + (58%) + (80%)
Klebsiella[11] + + + +
Proteus[12] + + + +
Neisseria gonorrhoeae[13] + (21.6%) +
Pseudomonas[14] + + + +
Staphylococcus + + + +
Chlamydia trachomatis[15][16][17] + + + (20–30%) +
Mycoplasma[18][19] + +
Trichomonas[20][21][22] + + + +

*Ecoli is the most common cause of all urinary tract infections[23]

Differential Diagnosis

Urinary tract infections should be differentiated from one another and from various other diseases:

Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Differentiating amongst different types of urinary tract infections:
Pyelonephritis + + + + Flank or costovertebral angle + + Identifies causative bacteria Urine culture
Cystitis + + + + + + Suprapubic + >100,000CFU/mL Urine culture
Urethritis + + + Urethral discharge + Gram stain & mucoid or purulent discharge
Prostatitis + + + + + Identifies causative bacteria (in bacterial subtypes) Urine culture
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard
Differentiating UTIs from other diseases:
Vulvovagintis + + Vaginal discharge  + Gram stain & culture of discharge
  • Number and type of sexual partners (new, casual, or regular)
  • Prior STDs
  • Previous history of symptomatic BV in female partner (in homosexual women)
Cervicitis + + + Cervical Endocervical exudate Culture for gonococcal cervicitis
Epididymitis + + + + + Testicular & suprapubic +/– urethral discharge + + Culture
Syphilis

(STD)

+/– + Darkfield microscopy
BPH + + + + DRE

& Serum PSA

Neoplasms + + + +/– + Imaging and biopsy
Diseases Symptoms Physical Examination Diagnostic tests Past medical history Other Findings
Hematuria Pyuria Frequency Urgency Dysuria Fever Tenderness Discharge Inguinal Lymphadenopathy Urinalysis Urine Culture Gold Standard

References

  1. Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
  2. Colgan R, Williams M (2011). "Diagnosis and treatment of acute uncomplicated cystitis". Am Fam Physician. 84 (7): 771–6. PMID 22010614.
  3. Bremnor JD, Sadovsky R (2002). "Evaluation of dysuria in adults". Am Fam Physician. 65 (8): 1589–96. PMID 11989635.
  4. Kurowski K (1998). "The woman with dysuria". Am Fam Physician. 57 (9): 2155–64, 2169–70. PMID 9606306.
  5. Urinary Tract Infections in Adults. NIDDK 2016. http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/Pages/facts.aspx. Accessed on February 9, 2016
  6. Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB (2008). "A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis". Urology. 71 (1): 17–22. doi:10.1016/j.urology.2007.09.002. PMID 18242357.
  7. R. M. Echols, R. L. Tosiello, D. C. Haverstock & A. D. Tice (1999). "Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 29 (1): 113–119. doi:10.1086/520138. PMID 10433573.
  8. Manuel Etienne, Pascal Chavanet, Louis Sibert, Frederic Michel, Herve Levesque, Bernard Lorcerie, Jean Doucet, Pierre Pfitzenmeyer & Francois Caron (2008). "Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis". BMC infectious diseases. 8: 12. doi:10.1186/1471-2334-8-12. PMID 18234108.
  9. James B. Hill, Jeanne S. Sheffield, Donald D. McIntire & George D. Jr Wendel (2005). "Acute pyelonephritis in pregnancy". Obstetrics and gynecology. 105 (1): 18–23. doi:10.1097/01.AOG.0000149154.96285.a0. PMID 15625136.
  10. Rebecca E. Watts, Viktoria Hancock, Cheryl-Lynn Y. Ong, Rebecca Munk Vejborg, Amanda N. Mabbett, Makrina Totsika, David F. Looke, Graeme R. Nimmo, Per Klemm & Mark A. Schembri (2010). "Escherichia coli isolates causing asymptomatic bacteriuria in catheterized and noncatheterized individuals possess similar virulence properties". Journal of clinical microbiology. 48 (7): 2449–2458. doi:10.1128/JCM.01611-09. PMID 20444967.
  11. R. M. Echols, R. L. Tosiello, D. C. Haverstock & A. D. Tice (1999). "Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 29 (1): 113–119. doi:10.1086/520138. PMID 10433573.
  12. R. M. Echols, R. L. Tosiello, D. C. Haverstock & A. D. Tice (1999). "Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis". Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 29 (1): 113–119. doi:10.1086/520138. PMID 10433573.
  13. Stephanie N. Taylor, Oliver Liesenfeld, Rebecca A. Lillis, Barbara A. Body, Melinda Nye, James Williams, Carol Eisenhut, Edward W. 3rd Hook & Barbara Van Der Pol (2012). "Evaluation of the Roche cobas(R) CT/NG test for detection of Chlamydia trachomatis and Neisseria gonorrhoeae in male urine". Sexually transmitted diseases. 39 (7): 543–549. doi:10.1097/OLQ.0b013e31824e26ff. PMID 22706217.
  14. Allan Ronald (2002). "The etiology of urinary tract infection: traditional and emerging pathogens". The American journal of medicine. 113 Suppl 1A: 14S–19S. PMID 12113867.
  15. J. Dimitrakov, V. Ganev, T. Zlatanov, I. Detchev, A. Horvat, S. Kirov, I. Vatchkova & D. Dimitrakov (1998). "PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis". Folia medica. 40 (3): 24–28. PMID 10658351.
  16. J. Dimitrakov, V. Ganev, T. Zlatanov, I. Detchev, A. Horvat, S. Kirov, I. Vatchkova & D. Dimitrakov (1998). "PCR studies on the presence of Chlamydia trachomatis in the upper urinary tract of patients with obstructive pyelonephritis". Folia medica. 40 (3): 24–28. PMID 10658351.
  17. Matthew J. Perkins & Catherine F. Decker (2016). "Non-gonococcal urethritis". Disease-a-month : DM. 62 (8): 274–279. doi:10.1016/j.disamonth.2016.03.011. PMID 27107783.
  18. Iu L. Naboka, L. I. Vasil'eva, M. I. Kogan, I. A. Gudima & I. Iu Suchkov (2009). "[Microbial associations defecting in children with chronic pyelonephritis]". Zhurnal mikrobiologii, epidemiologii, i immunobiologii (5): 8–12. PMID 20063785.
  19. Iu L. Naboka, L. I. Vasil'eva, M. I. Kogan, I. A. Gudima & I. Iu Suchkov (2009). "[Microbial associations defecting in children with chronic pyelonephritis]". Zhurnal mikrobiologii, epidemiologii, i immunobiologii (5): 8–12. PMID 20063785.
  20. Template:Hoffman, David J., et al. "Urinary tract infection with Trichomonas vaginalis in a premature newborn infant and the development of chronic lung disease." Journal of perinatology 23.1 (2003): 59-61.
  21. L. SYLVESTRE, M. BELANGER & Z. GALLAI (1960). "Urogenital trichomoniasis in the male: review of the literature and report on treatment of 37 patients by a new nitroimidazole derivative (Flagyl)". Canadian Medical Association journal. 83: 1195–1199. PMID 13774369.
  22. Template:Kuberski, Tim. "Trichomonas vaginalis associated with nongonococcal urethritis and prostatitis." Sexually transmitted diseases 7.3 (1979): 135-136.
  23. Matthew J. Perkins & Catherine F. Decker (2016). "Non-gonococcal urethritis". Disease-a-month : DM. 62 (8): 274–279. doi:10.1016/j.disamonth.2016.03.011. PMID 27107783.